Platinum Priority – Bladder CancerEditorial by Vincenzo Serretta on pp. 911–913 of this issueClinical Outcome in a Contemporary Series of Restaged Patients with Clinical T1 Bladder Cancer☆
Introduction
Bladder cancer presents as non–muscle-invasive papillary tumors in 75–85% of cases [1]; 20% of such tumors invade the lamina propria (T1) [2]. Although both Ta and T1 tumors commonly recur, T1 cancers are potentially more lethal because 30–50% progress to muscle invasion or metastasis [3]. Multiple tumors, high-grade morphology, large (>3 cm) size, associated carcinoma in situ (CIS), lymphovascular invasion, depth of lamina propria penetration, and presence of tumor at first follow-up cystoscopy are associated with greater risk of stage progression and reduced survival [4], [5].
Management of T1 bladder cancer is a dynamic process. Some patients undergo immediate cystectomy while others are placed on long-term surveillance with the possibility of a deferred cystectomy. Although the choice of treatment takes into account several factors including multifocality, associated CIS, the presence of multifocal T1 disease, the presence of residual tumor at restaging transurethral resection (TUR), and prior history of bacillus Calmette-Guérin (BCG) treatment, there are no definite guidelines for selecting patients’ initial treatment. The objective of this study is to define the indications for early cystectomy or surveillance and to report the impact of this approach on survival.
Section snippets
Subjects and inclusion criteria
An institutional review board–approved, retrospective review of the institutional database was performed to identify patients with clinical T1 (cT1) transitional cell carcinoma (TCC) of the bladder. Diagnosis of cT1 disease was based on cystoscopy, bimanual examination, radiographic tests, and pathologic evaluation. Patients whose pathology slides were not available for review and patients with non-TCC were excluded; however, TCC with aberrant differentiation was included. All tumors were
Results
We identified 523 patients with cT1 TCC of the bladder who were restaged (Table 1). The diagnostic TUR was performed at Memorial Sloan-Kettering Cancer Center (MSKCC) for 144 patients (28%). The restaging TUR was performed at MSKCC for 83% of patients (435 of 523) and at an outside institution for the rest. Overall, 106 (20%) patients were upstaged to muscle-invasive disease. A similar proportion of patients were upstaged to T2 disease, regardless of where the restaging TUR was performed (21%
Discussion
Conservative management of T1 bladder cancer seeks to preserve the bladder while preventing death from progressive bladder cancer. It is a dynamic process that, to be successful, requires (1) careful selection of appropriate patients based on accurate initial pathologic staging and restaging with TUR; (2) identification of prognostic indicators, which include pathologic characteristics of the tumors, biologic markers, and the clinical response to BCG; and (3) adequate treatment, including
Conclusions
Conservative management of cT1 bladder cancer depends on careful selection and monitoring of patients. All patients being considered for conservative management should undergo restaging TUR to allow for better risk assessment. Patients with T1 disease on restaging are at high risk of progression and should be considered for early cystectomy.
Author contributions: Guido Dalbagni had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of
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Does repeat transurethral resection of bladder tumor influence the diagnosis and prognosis of T1 bladder cancer? A systematic review and meta-analysis
2023, European Journal of Surgical OncologyQuality Indicators for Bladder Cancer Services: A Collaborative Review[Formula presented]
2020, European UrologyCitation Excerpt :Residual disease after resection of T1 tumours has been seen in up to 55% of patients [45]. Without restaging TURBT, there is a high likelihood of understaging, as muscle-invasive disease is detected by second resection of initially T1 tumours in up to 25% of cases and rises to 45% if there was no muscle in the initial resection [46]. For patients with Ta high-grade (HG) on initial TURBT, various guidelines state different recommendations regarding repeat TURBT.
Neoplasms of the Urinary Bladder
2020, Urologic Surgical Pathology
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